Overview
Understanding the disease
Symptoms
Symptoms of diabetic nephropathy may include worsening blood pressure control, protein in the urine, swelling of feet, ankles, hands, or eyes, increased need to urinate, reduced need for insulin or diabetes medicine, confusion or difficulty concentrating, shortness of breath, loss of appetite, nausea and vomiting, persistent itching, and fatigue. If you experience any of these symptoms, it is essential to consult your doctor for proper evaluation and management of the condition.
Risk Factors
Risk factors for developing diabetic nephropathy include uncontrolled high blood sugar (hyperglycemia), uncontrolled high blood pressure (hypertension), being a smoker, and having a family history of diabetes and kidney disease. Other factors that increase the risk of kidney disease include obesity, high blood cholesterol, and a history of bone and mineral disorders due to the inability of the kidneys to maintain the right balance of calcium and phosphorus in the blood. Additionally, pregnancy complications that carry risks for the mother and the developing fetus can contribute to diabetic nephropathy.
Development
Diabetic nephropathy develops when diabetes damages blood vessels and other cells in the kidneys, particularly the blood vessel clusters called glomeruli that are responsible for filtering waste from the blood. Over time, poorly controlled diabetes can cause damage to these glomeruli, leading to kidney damage and increasing the risk of high blood pressure. High blood pressure further strains the kidneys and can cause additional damage to the delicate filtering system. Risk factors for developing diabetic nephropathy include uncontrolled high blood sugar, uncontrolled high blood pressure, smoking, high blood cholesterol, obesity, and a family history of diabetes and kidney disease.
Assessment and Diagnosis
Triage
You should see a doctor if you have any signs or symptoms of kidney disease, especially if you have diabetes. Early detection might help prevent kidney disease from progressing to kidney failure. If you have a medical condition that increases your risk of kidney disease, your doctor may monitor your kidney function with urine and blood tests during office visits.
Diagnosis
Diabetic nephropathy (kidney disease) can be diagnosed through routine testing that is a part of diabetes management. The tests may include a urinary albumin test to detect blood protein albumin in your urine, which indicates poor kidney function. Another test, the albumin/creatinine ratio, measures the albumin level in urine relative to creatinine, which provides an indication of kidney function. If you've been recently diagnosed with diabetic nephropathy, you should discuss your kidney function status, recommended treatments, and how to monitor changes in kidney function with your doctor. Regular appointments with your diabetes treatment team should include discussions about monitoring your blood sugar levels and target ranges.
Management and Treatment
Complications
Complications of diabetic nephropathy may include fluid retention, which could lead to swelling in your arms and legs, high blood pressure, or fluid in your lungs (pulmonary edema). Other complications may involve heart and blood vessel disease, damage to the blood vessels of the light-sensitive tissue at the back of the eye, reduced number of red blood cells to transport oxygen, foot sores, erectile dysfunction, diarrhea, and other problems related to damaged nerves and blood vessels. Additionally, bone and mineral disorders due to the inability of the kidneys to maintain the right balance of calcium and phosphorus in the blood can occur.
Home Remedies
It is important to consult a healthcare professional for advice on managing diabetic nephropathy, as they can provide personalized guidance based on your specific condition and medical history.
Treatment
To treat diabetic nephropathy, the first step is to manage and control diabetes and high blood pressure. This involves a healthy diet, lifestyle changes, exercise, and prescribed medications. In the early stages, medications like ACE inhibitors and ARBs may be used for blood pressure control. It's essential to maintain a healthy weight, eat a high-fiber diet, limit saturated fats and sodium, and quit smoking. Diabetes care teams can help with blood sugar and blood pressure management. For those not opting for dialysis or a kidney transplant, symptom management can help maintain comfort. Potential future treatments, such as regenerative medicine and new medications, are still under investigation.
Preparing for medical consultation
To prepare for an appointment for diabetic nephropathy, you can:
- Ask your doctor's office about any necessary fasting or other restrictions for blood tests or other examinations.
- Make a list of your symptoms, including those that may not seem related to diabetic nephropathy, and when they began. Be prepared to discuss your urination frequency and daily water intake.
- Compile key personal information, such as recent life stresses, major changes, and any other medical conditions you have experienced.
- Gather a list of your current medications, dosages, and any recent surgeries.
- Bring a family member or friend to the appointment for support and to help remember important details.
- Prepare a list of questions to ask your healthcare provider about your condition and treatment options. Remember to discuss your concerns and ask any questions you may have during the appointment.